Breathing assistance apparatus

ABSTRACT

A breathing assistance apparatus and method of controlling a breathing assistance apparatus is disclosed. Particularly, the breathing assistance apparatus is controlled such that it has a drying cycle to enable drying of the tubing that supplies gases to a user and prevent the harboring of pathogens within the tube. The drying cycle is preferably operated automatically by internal controllers in the apparatus. However, it may be manually activated by pressing a button on the apparatus. The drying cycle is preferably activated at the end of a user&#39;s treatment session.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

Any and all applications for which a foreign or domestic priority claimis identified in the Application Data Sheet as filed with the presentapplication are hereby incorporated by reference under 37 CFR 1.57.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to a breathing gases supply and gaseshumidification apparatus and a method of controlling such apparatus.Uses for the breathing assistance apparatus of the present invention arethe supply of gases for any medical condition or treatment that resultsin the drying of the upper airways, and/or salivary glands, such as heador neck radiotherapy or long term oxygen therapy. Further uses are formedical conditions that result in impaired mucociliary clearance systemssuch as Chronic Obstructive Pulmonary Disease (COPD) or bronchiectasisor in the supply of Continuous Positive Airway Pressure (CPAP) to treatObstructive Sleep Apnoea (OSA) or other respiratory conditions.

2. Description of the Related Art

A number of methods are known in the art for assisting a patient'sbreathing. Continuous Positive Airway Pressure (CPAP) involves theadministration of air under pressure to a patient, usually by a nasalmask. It is used in the treatment of snoring and Obstructive SleepApnoea (OSA), a condition characterised by repetitive collapse of theupper airway during inspiration. Positive pressure splints the upperairway open, preventing its collapse. Treatment of OSA with nasal CPAPhas proven to be both effective and safe, but CPAP is difficult to useand the majority of patients experience significant side effects,particularly in the early stages of treatment.

CPAP is also commonly used for patients with a variety of respiratoryillnesses, including COPD.

Upper airway symptoms adversely affect treatment with CPAP. Mucosaldrying is uncomfortable and may awaken patients during the night.Rebound nasal congestion commonly occurs during the following day,simulating a viral infection. If untreated, upper airway symptomsadversely affect rates of CPAP use.

Increases in nasal resistance may affect the level of CPAP treatmentdelivered to the pharynx, and reduce the effectiveness of treatment. Anindividual pressure is determined for each patient using CPAP and thispressure is set at the patient interface. Changes in nasal resistanceaffect pressure delivered to the pharynx and if the changes are ofsufficient magnitude there may be recurrence of snoring or airwaycollapse or reduce the level of pressure applied to the lungs. Suchsymptoms can also occur in a hospital environment where a patient is ona respirator. Typically in such situations the patient is intubated.Therefore the throat tissue may become irritated and inflamed causingboth distress to the patient and possible further respiratory problems.

A number of methods may be employed to treat such upper airway symptoms,including pharmacological agents to reduce nasal disease, or heating thebedroom. One most commonly employed method is humidification of theinspired air using an in line humidifier. Two types of humidifier arecurrently used. Cold pass-over humidifiers rely on humidifying the airthrough exposure to a large surface area of water. While they are cheap,the humidity output is low at high flows, typically 2 to 4 mgL absolutehumidity at flows above 25 L/min. The output is insufficient to preventmucosal drying. Heated water bath humidifiers are more efficient, andproduce high levels of humidity even at high flow rates. They areeffective at preventing upper airway mucosal drying, prevent increasesin nasal resistance, and are the most reliable means of treating upperairway symptoms.

Oxygen is the most common drug prescribed to hospitalized patients. Thedelivery of oxygen via nasal cannula or facemask is of benefit to apatient complaining of breathlessness. By increasing the fraction ofinspired oxygen, oxygen therapy reduces the effort to breathe and cancorrect resulting hypoxia (a low level of oxygen in the tissues).

The duration of the therapy depends on the underlying illness. Forexample, postoperative patients may only receive oxygen while recoveringfrom surgery while patients with COPD require oxygen 16 to 18 hours perday.

Currently greater than 16 million adults are afflicted with COPD, anumbrella term which describes a group of lung diseases characterized byirreversible airflow limitation that is associated mainly with emphysemaand chronic bronchitis, most commonly caused by smoking over severaldecades. When airway limitation is moderately advanced, it manifests asperpetual breathlessness, without physical exertion. Situations such asa tracheobronchial infection, heart failure and also environmentalexposure can incite an exacerbation of COPD that requireshospitalization until the acute breathlessness is under control. Duringan acute exacerbation of COPD, the patient experiences an increase indifficulty of breathing (dyspnea), hypoxia, and increase in sputumvolume and purulence and increased coughing.

Oxygen therapy provides enormous benefit to patients with an acuteexacerbation of COPD who are hypoxic, by decreasing the risk of vitalorgan failure and reducing dyspnea. The major complication associatedwith oxygen therapy is hypercarpnia (an elevation in blood carbondioxide levels) and subsequent respiratory failure. Therefore, the doseof oxygen administered can be critical and must be precisely known.

To accurately control the oxygen dose given to a patient, theoxygen-enriched gas must exceed the patient's peak inspiratory flow toprevent the entrainment of room air and dilution of the oxygen. Toachieve this, flows of greater than 20 L/min are common. Such flows ofdry gases cause dehydration and inflammation of the nasal passages andairways if delivered by nasal cannula. To avoid this occurrence, aheated humidifier is used.

The majority of systems that are used for oxygen therapy or merelydelivery of gases to a patient consists of a gases supply, a humidifierand conduit. Interfaces include face masks, oral mouthpieces,tracheostomy inlets and nasal cannula, the latter having the advantageof being more comfortable and acceptable than a facemask.

It is usual for the gases supply to provide a constant, prescribed levelof gases flow to the humidifier. The humidifier and conduit can thenheat and humidify the gases to a set temperature and humidity beforedelivery to the patient. It is important to note that the warm-up timerequired from start-up for the gases to reach optimal temperature andhumidity increases with higher flow rates. The operating instructions ofsuch a system commonly instruct the user not to connect the system tothe patient until the humidifier has completed the warm-up period.Thereafter, patients receive up to 40 L/min of near body temperaturesaturated gases. Patients often feel overwhelmed by sudden delivery ofhigh flow at this time.

A group of patients who would benefit from humidification therapy arepatients who have mucociliary clearance deficiencies. These patientsoften have purulent mucus and are susceptible to infections frompathogens. Heated humidified air with an abundance of water particles isan ideal medium to harbour disease carrying pathogens. Consequently,considerable design expertise has been required to provide the marketwith active pass-over humidifiers that deliver water molecules, in gasphase only, so that it is not possible for disease pathogens to becarried in air to the patient. Water that condenses on the innersurfaces of the breathing circuit or conduit at the end of a treatmentsession may harbour pathogens that would be delivered to the patientnext time they use the device. This is particularly the case withtherapies for COPD patients that are receiving body temperature fullysaturated air.

The hygiene of a breathing circuit (the tubing supplying humidifiedgases to a patient) is particularly important when the humidificationtherapy is used for the treatment of respiratory diseases. Any moistureremaining in the breathing circuit at the end of a treatment may harbourpathogens exhaled or expelled (as mucus may be expelled into the circuitor patient interface) by the patient. This moisture provides a means totransport the pathogens in the tubing providing a source of furtherinfection for the patient when the tubing is next used. Often with suchtreatment the tubing is not cleaned daily and therefore must bethoroughly dried at the end of treatment. This cleaning is timeconsuming and will not always be carried out to precise instructions.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide a breathingassistance apparatus which goes some way to overcoming theabovementioned disadvantages or which at least provides the public orindustry with a useful choice.

Accordingly in a first aspect the present invention consists in abreathing assistance apparatus adapted to deliver humidified gases at adesired level of humidity, flow and temperature for treatment of apatient comprising: a) gases supply means providing a flow of gases, b)a humidifier having a chamber adapted to receive a volume of water and achamber heater to heat said water in said chamber, said chamberincluding an inlet and an outlet, c) transportation pathway means toconvey said humidified gases from said humidifier to said patient, d) acontroller having stored instructions to complete the following steps atthe end of said treatment of said patient: i) switch off power to saidchamber heater, ii) set said flow of gases from said gases supply meansto a predetermined flow for a predetermined time, iii) after saidpredetermined time switch off said gases supply means.

Preferably said transportation pathway means has a pathway heater, andsaid apparatus further comprises: a) an outlet temperature sensormeasuring the temperature of said gases at said outlet to said chamber,b) a distal temperature sensor measuring the temperature of said gasesat the distal end of the transportation pathway means, c) an ambienttemperature sensor measuring ambient air temperature, and saidcontroller includes stored instructions to: i) control said pathwayheater over said predetermined time such that the temperature of saidgases at the distal end of said transportation pathway means, as sensedby said second sensor does not exceed a safe temperature level, and ii)monitor said outlet gases temperature sensor and said ambient airtemperature sensor, compare said outlet gases temperature and saidambient air temperature and when these are substantially equal end saidpredetermined time and switch of said gases supply means and saidpathway heater.

Preferably said transportation pathway means has a pathway heater, andsaid apparatus further comprises: a) a distal temperature sensormeasuring the temperature of said gases at the distal end of thetransportation pathway means, b) an ambient temperature sensor measuringambient air temperature, c) a chamber heater temperature sensormeasuring said chamber heater temperature, and said controller includesstored instructions to: i) control said pathway heater over saidpredetermined time such that the temperature of said gases at the distalend of said transportation pathway means, as sensed by said secondsensor does not exceed a safe temperature level, and ii) monitor saidchamber heater temperature sensor and ambient air temperature sensor,compare said chamber heater temperature and said ambient air temperatureand when these are substantially equal end said predetermined time andswitch off said gases supply means and said pathway heater.

Preferably said transportation pathway means is an extruded plastictube, and said pathway heater is at least two conductive wires embeddedwithin, throughout or about the wall of said tube.

Preferably said controller includes stored instructions to determinesaid end of said treatment when said patient activates an “off” buttonconnected to said controller.

Alternatively said apparatus further comprises a patient interfacesensor, and said controller includes stored instructions to determinesaid end of said treatment when said patient interface sensor detectsthat said patient has removed said patient interface for a predeterminedperiod of time.

Alternatively said controller includes stored instructions to determinesaid end of treatment when a substantial increase of flow of gases isdetected exiting said gas supply means for a predetermined period oftime.

Alternatively said apparatus further comprises a patient interfacesensor, and said controller includes stored instructions to determinesaid end of treatment when said patient interface sensor senses thatsaid patient's breathing through said patient interface has ceased for apredetermined period of time.

In a second aspect the present invention consists in a method ofcontrolling a breathing assistance apparatus where said apparatus isadapted to deliver humidified gases at a desired level of humidity, flowand temperature for treatment of a patient, said apparatus comprising agases supply means providing a flow of gases, a humidifier having achamber adapted to receive a volume of water and a chamber heater toheat said water in said chamber, transportation pathway means to conveysaid humidified gases from said humidifier to said patient, and acontroller that stores a program which causes the controller at the endof said treatment of said patient to: a) switch off power to saidchamber heater, b) set said flow of gases from said gases supply meansto a predetermined flow for a predetermined time, c) after saidpredetermined time switch off said gases supply means.

Preferably said transportation pathway means has a pathway heater, andsaid apparatus further comprises an outlet temperature sensor measuringthe temperature of said gases at said outlet to said chamber, a distaltemperature sensor measuring the temperature of said gases at the distalend of the transportation pathway means, an ambient temperature sensormeasuring ambient air temperature, and said program further causes saidcontroller to: a) control said pathway heater over said predeterminedtime such that the temperature of said gases at the distal end of saidtransportation pathway means, as sensed by said second sensor does notexceed a safe temperature level, and b) monitor said outlet gasestemperature sensor and said ambient air temperature sensor, compare saidoutlet gases temperature and said ambient air temperature and when theseare substantially equal end said predetermined time and switch of saidgases supply means and said pathway heater.

Preferably said transportation pathway means has a pathway heater, andsaid apparatus further comprises a distal temperature sensor measuringthe temperature of said gases at the distal end of the transportationpathway means, an ambient temperature sensor measuring ambient airtemperature, a chamber heater temperature sensor measuring said chamberheater temperature, and said program further causes said controller to:a) control said pathway heater over said predetermined time such thatthe temperature of said gases at the distal end of said transportationpathway means, as sensed by said second sensor does not exceed a safetemperature level, and b) monitor said chamber heater temperature sensorand ambient air temperature sensor, compare said chamber heatertemperature and said ambient air temperature and when these aresubstantially equal end said predetermined time and switch off saidgases supply means and said pathway heater.

Preferably said program further causes said controller to determine saidend of said treatment when said patient activates an “off” buttonconnected to said controller.

Alternatively said apparatus further comprises a patient interfacesensor and said program further causes said controller to determine saidend of said treatment when said patient interface sensor detects thatsaid patient has removed said patient interface for a predeterminedperiod of time.

Alternatively said program further causes said controller to determinesaid end of treatment when a substantial increase of flow of gases isdetected exiting said gas supply means for a predetermined period oftime.

Alternatively said apparatus further comprises a patient interfacesensor and said program further causes said controller to determine saidend of treatment when said patient interface sensor senses that saidpatient's breathing through said patient interface has ceased for apredetermined period of time.

To those skilled in the art to which the invention relates, many changesin construction and widely differing embodiments and applications of theinvention will suggest themselves without departing from the scope ofthe invention as defined in the appended claims. The disclosures and thedescriptions herein are purely illustrative and are not intended to bein any sense limiting.

In this specification where reference has been made to patentspecifications, other external documents, or other sources ofinformation, this is generally for the purpose of providing a contextfor discussing the features of the invention. Unless specifically statedotherwise, reference to such external documents is not to be construedas an admission that such documents, or such sources of information, inany jurisdiction, are prior art, or form part of the common generalknowledge in the art.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred forms of the present invention will now be described withreference to the accompanying drawings.

FIG. 1 is an illustration of the breathing assistance apparatus that thecontrol method of the present invention may be used with.

FIG. 2 is a perspective view of a combined gases supply and humidifierof the breathing assistance apparatus of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

A breathing assistance apparatus and method of controlling a breathingassistance apparatus is detailed below. Particularly, the breathingassistance apparatus is controlled such that it has a drying cycle toenable drying of the tubing that supplies gases to a user and preventthe harbouring of pathogens within the tube. The drying cycle ispreferably operated automatically by internal controllers in theapparatus. However, it may be manually activated by pressing a button onthe apparatus. The drying cycle is preferably activated at the end of apatient's treatment session.

The breathing assistance apparatus of the present invention is intendedto typically deliver body temperature saturated gases (37.degree. C. and44 mg/L) over a range of flows that could provide up to a patient'sinspiratory flow requirements (that is, peak inspiratory flow) plus anybias flow requirement.

The breathing assistance apparatus operates as a flow controlled device,so it adjusts the flow of gases to the level set by the patient or user,such as a care giver. Therefore, this apparatus can be used to deliverhumidified gas for patients with bypassed airways, such as tracheotomiesor nasal cannula or masks.

Whether used in a hospital environment or in a home care environment,the breathing assistance apparatus of the present invention willgenerally have associated with it a gases supply means, such as ambientair, gases, such as oxygen from cylinders or other compressed gassupply, humidification means and a transport conduit from thehumidification means to the patient, which is preferably heated toreduce condensation.

A heating element is preferably provided within the transport conduit tohelp prevent condensation of the humidified gases within the conduit.Such condensation is due to the temperature of the walls of the conduitbeing lower than to the dew point of the gases inside the conduit, whichis usually lower than the temperature of the humidified gases within theconduit. The heating element effectively replaces the energy lost fromthe gases through conduction and convection during transit through theconduit and the patient interface. Thus the conduit heating elementensures the gases delivered are at an optimal temperature and humidityfor patient treatment and to minimise condensation within the transportconduit and the patient interface.

The present invention provides a breathing assistance apparatus wherethe flow of gases passes in sequence through a gases supply means orflow driver (such as, a blower, fan or compressor), humidificationchamber, heated delivery circuit and patient interface, such as thatshown in FIG. 1.

With reference to FIG. 1 the humidification apparatus of the presentinvention is shown in which a patient 1 is receiving humidified andpressurised gases through a nasal cannula 20 connected to a humidifiedgases transportation pathway or inspiratory conduit 3 that in turn isconnected to a humidifier 8 (including humidification chamber 5) that issupplied with gases from a blower 15 or other appropriate gases supplymeans. The inspiratory conduit 3 is connected to the outlet 4 of ahumidification chamber 5 which contains a volume of water 6. Inspiratoryconduit 3 contains heating means or heater wires 11 that heat the wallsof the conduit to reduce condensation of humidified gases within theconduit and the patient interface (e.g. nasal cannula 20). Thehumidification chamber 5 is preferably formed from a plastics materialand may have a highly heat conductive base (for example an aluminiumbase) which is in direct contact with a heater plate 7 of humidifier 8.The humidifier 8 is provided with control means or electronic controller9 which may comprise a microprocessor based controller executingcomputer software commands stored in associated memory.

Gases flowing through the inspiratory conduit 3 are passed to thepatient by way of a patient interface 20. The patient interface usedwith the apparatus of the present invention may be a full-face mask,nasal mask, nasal cannula, oral mouthpiece or tracheostomy connection.

Controller 9 receives input from sources such as user input means ordial 10 through which a user of the device may, for example, set apredetermined required value (preset value) of humidity or temperatureof the gases supplied to patient 1. In response to the user set humidityor temperature value input via dial (or buttons) 10 and other possibleinputs such as internal sensors that sense gases flow or temperature, orby parameters calculated in the controller, controller 9 determines when(or to what level) to energise heater plate 7 to heat the water 6 withinhumidification chamber 5. As the volume of water 6 within humidificationchamber 5 is heated, water vapour begins to fill the volume of thechamber above the water's surface and is passed out of thehumidification chamber 5 outlet 4 with the flow of gases (for exampleair) provided from a gases supply means or blower 15 which enters thechamber 5 through inlet 16. It should be noted that it is possible toobtain the relationship between the humidity of the gases inhumidification chamber 5 and the temperature of the heater plate 7.Accordingly, it is possible to utilise the heater plate temperature inan algorithm or a look-up table to determine the humidity of the gases.

It is also possible to measure the chamber outlet gases temperature fromthe humidification chamber 5 using a temperature sensor 12 and use thisto determine the humidity of the gases in the chamber 5 and conduit 3.

The blower 15 may be provided with a variable speed pump or fan 2 whichdraws air or other gases through the blower inlet 17. The speed ofvariable speed pump or fan 2 may be controlled by a further controlmeans or electronic controller 18 (or alternatively the function of thiscontroller 18 could be carried out by the other controller 9) inresponse to inputs from controller 9 and a user set predeterminedrequired value (preset value) of pressure or fan speed via dial 19.

In the preferred embodiment shown in FIG. 2 the breathing assistanceapparatus of the present invention the gases supply or blower iscombined in one housing with the humidifier and humidification chamber.The humidification chamber 35 extends out from the housing 30 and iscapable in use of being removed and replaced by the patient or otheruser. Also, the inlet port (not shown) to the humidification chamber 35is internal within the housing 30. The inlet 31 to the housing 30 wheregases are drawn from the ambient air outside the housing 30 is locatedat the end of the housing 30, but in actuality may be located at anyappropriate point in the housing 30. The gases exit from thehumidification chamber 35 at the outlet 33 and water within the chamber35 is heated by a heater plate 36, similar to that described above. Itmust be appreciated that the embodiment described above in relation tothe housing and FIG. 2 merely illustrates one form of the housing of thecombined gases supply and humidifier of the present invention.

In one preferred form of the apparatus of the present invention, a nasalcannula 20 is used as the patient interface. The initial connection of apatient 1 to a blower and humidifier is an obstacle to patientcompliance and negates a patient's comfort and tolerance due to the highpressure supply of gases through the cannula. Therefore, it would beadvantageous if the gases flow was slowly increased to the patient,allowing their body time to adjust to the temperature, sensation offlow, and pressure in their nasopharynx. This slow increase in flow maybe over a considerable time, such as 30 minutes, allowing the patient toslowly adjust to the therapy instead of feeling overwhelmed with thesudden delivery to the nasal passage, of up to 40 L/min of saturatedgases.

As discussed earlier, high flows of non-humidified gases delivered tothe patients airways causes dehydration and inflammation of the airwaysand nasal passages. At low flows (such as 5 liters per minute) a lowerlevel of humidity is adequate. Because an active pass-over humidifier 8holds a humidification chamber 5 which contains a volume of water 6,this water has a large thermal mass and takes time to heat up enough toprovide adequate humidity at high flows.

Warm Up Mode

The blower 15 may be controlled by a controller (18 or 9) such that onstart-up or commencement of therapy by the patient 1 the flow rate ofgases exiting the blower 15 is initially supplied as a low flow.

Under the warm up mode the aim is to deliver optimal gas to the patient.To do this, it is necessary to warm up the gases in the chamber asquickly as possible to a set value, most preferably 37.degree. C. As thetemperature of the gases at the chamber outlet are measured by a sensorthis is the temperature that is to be controlled to the set temperaturevalue. In this way the patient is supplied with an optimal temperatureof gases as soon as possible. This is achieved by; turning on the heaterplate 7 to full heating output, providing a low flow of gases throughthe humidification chamber 5 and controlling the wall temperature of theheated conduit 3 to avoid condensation. When the gases temperature inthe humidification chamber 5 reaches the set temperature the gases flowis increased to the predetermined therapy flow as fast as possible,while maintaining the gases temperature in the chamber at the settemperature. The increasing of the gases flow is performed bycontrolling (increasing) the speed of the fan 21 in the blower 15.Alternatively, when the water chamber gases reach the set temperaturethe flow is increased to the target or predetermined flow for thetherapy. As soon as the gases temperature in the water chamber recoversto approximately the set temperature, for example, 35.degree. C., asignal is given by the controller that the patient can now wear theinterface.

As an example, gases flow is increased from the initial low flow(flow.sub.initial) to a flow that is optimal (flow.sub.opt) for thetherapy being provided. It is preferred that the maximum or optimum flowlevel (flow.sub.opt) is selectable by the user or care provider by wayof dial 19. In this case, the controller 18 or 9 would control the flowrate, by controlling the fan 21 speed so that the gases flow isinitially at a low flow rate of, for example, 5 L/min. Alternatively,the gases flow could be switched on for, for example, 1 to 15 seconds,at a low flow of, for example, 5 L/min to allow the temperature andhumidity readings to be taken. Then the gases flow would be switched offfor a period of time, for example, 5 to 60 seconds, to allow thehumidity in the chamber to rise quicker.

Once the temperature the gases exiting the humidifier chamber reaches37.degree. C. (the set temperature), the flow of the gases is ramped upover a predetermined time, for example, 30 minutes, to an optimum flowlevel (flow.sub.opt) of between 15 to 40 L/min, as selected by thepatient.

The above sequence of events enables the humidity in the breathingcircuit to reach the desired level as quickly as possible whileminimising condensation and/or thermal overshoot.

Drying Mode

To overcome the problem of any condensation left in the conduit 3 or inthe patient interface 20 at the end of a therapy treatment session, thebreathing assistance apparatus of the present invention provides a modeor cycle of drying out the conduit 3 and potentially the interface 20.This is carried out by providing a turn off process that facilitates thedrying of the conduit 3 and the patient interface 20.

A drying mode is critical in minimising the risk of pathogen transportvia the conduit 3 and interface 20 to the patient 1. A drying mode alsoensures there will be no condensation left in the conduit or patientinterface after a treatment session and in a next treatment session.Condensation can cause gurgling noises and surges in airflow at thebeginning of the next humidification session making treatmentuncomfortable for the patient.

Generally, the aim of the drying mode is to ensure the humidity of thegases in the chamber and conduit are at or below the ambient levels theapparatus is operating in. This is achieved by cooling the water in thehumidification chamber 5, while continuing to heat the conduit 3 and theinterface 20 to a temperature that exceeds the chamber outlet gasestemperature. This is continued until the humidifier water temperatureand temperature of the gases at the chamber outlet reach or approximateroom temperature. As the thermal mass of the water in the chamber 5exceeds the thermal mass of the plastic walls of the conduit 3,condensation may occur if the humidifier 8 and the blower fan 21 areturned off at the same time. To ensure this does not occur, at the endof treatment it is preferred that the heater plate 7 is turned off butpower is maintained to a heater wire 11 in the conduit 3.

The humidification means, humidifier 8, is controlled by the controlmeans (controller 9 or 18) at the completion of a patient's treatment.Therefore, when the patient selects “off”, a button on the apparatus, orthe controller detects the end of a therapy session, effectively onlythe heater plate 7 is powered down by the controller (9 or 18) and thehumidification apparatus is placed in a drying mode. During the dryingmode, it is preferred that power is maintained to the heater wire 11 andthe gases supply means or blower 15. As an example, the gases flowthrough the humidifier 8 and conduit 3 is a flow, such as 20 liters perminute for a period of time, for example 15 minutes, which will ensurethe conduit has dried inside. The gases flow may be a fixed gases flowor pulses of gases flow.

A temperature sensor 13 is preferably provided at the end of theconduit, nearest the patient. This end of conduit temperature sensor 13is connected to the controller 9, 18. The end of conduit sensor 13 maybe used to optimise drying of the conduit 3 by ensuring the gases at theend of the breathing circuit are at the maximum safe operatingtemperature, so that the temperature of the gases does not obtain alevel that might burn a patient or user.

Preferably it might be optimal to start at a low gases flow and then ata later stage increase the gases flow.

In some forms of the present invention the conduit may not include aheater wire. In this situation the controller would merely control theblower 15, such that gases and not heat from the heater wire within theconduit alone would dry the conduit.

Deactivation of Drying Mode

The point in time that the drying mode is deactivated may be determinedby a number of methods. The first of which is to measure the temperatureof gases at the chamber outlet 4. When the temperature of the gases atthe chamber outlet 4 drops below or equals ambient temperature (which ispreferably measured by an additional temperature sensor, for example,located at the blower 15 but connected to one of the controllers 9, 18)the blower 15 and heater wire 11 are powered off by the controller 9,18. In this way gases flow through the humidification chamber 6 and asthe heater plate 7 cools the humidity of the gases flowing through theconduit 3 reduces and the conduit 3 becomes drier.

A second method for determining when the drying mode is to bedeactivated by the controller 9, 18 is to turn off the power to thehumidification chamber 5 and maintain a gases flow through the conduit 3at a fixed speed or pulses and maintain power in the heater wire 11 toevaporate any condensate off the walls of the conduit 3. After apredetermined time, preferably in excess of one minute, the heater wire11 and flow source (blower) would be switched off.

Yet another method of controlling the drying of the conduit is to switchthe gases supply (blower) off and switch off the power to the heaterplate power. The controller 9, 18 would then compare the heater plate 7temperature with an ambient temperature that is measured either insideor outside the humidifier or blower (as previously described). When thistemperature difference or comparison is within a predetermined limit,which typically approximates zero, a flow of gases is caused to flow inthe same manner as described above.

It is possible that it could take longer to dry the condensate in theconduit than to cool the chamber. In this instance it may be necessaryto extend the drying mode for some time, for example, up to 30 minutesdepending on the ambient temperature of the water remaining in thechamber.

Alternative Methods of Activation of Drying Mode

It has been described that the drying mode is activated by the patientselecting or pressing an “off” button. An alternative method ofactivating the drying mode is to detect the patient 1 removing theinterface 20. This may be, for example, by detecting an increase in theflow from the blower due to decreased resistance at the patientinterface at the end of a humidification session. After a predeterminedtime period has elapsed, which is long enough to ensure the patient doesnot put the interface back on, the drying mode is commenced.

As a further alternative method the time at which the patient stopsbreathing into the patient interface 20 may be detected. This may bedetected by monitoring for a breathing pattern, for example using a flowsensor on the patient interface or in the blower. Once no breathing isfound and after waiting a predetermined time period the drying mode iscommenced.

In order for the apparatus to be fully powered down a user or patientmust disconnect the apparatus from the electrical power supply or forexample, hold a switch or power button down on the humidifier or blowerfor a period of time, for example, 5 seconds.

What is claimed is:
 1. A breathing assistance apparatus adapted todeliver humidified gases at a desired level of humidity, flow andtemperature for treatment of a patient, the apparatus comprising: a) agases supply arrangement providing a flow of gases, b) a humidifierhaving a chamber adapted to receive a volume of water and a chamberheater to heat the water in the chamber, the chamber including an inletand an outlet, c) a transportation pathway to convey the humidifiedgases from the humidifier to the patient, the transportation pathwaycomprising a pathway heater having a distal end and a proximal end, theproximal end being adjacent the humidifier, the pathway heater beingconfigured to heat the transportation pathway, and d) a controllerhaving stored instructions to complete the following steps following aconclusion of treatment of the patient: i) switch off power to thechamber heater, ii) set the flow of gases from the gases supplyarrangement for a predetermined time, and switch off power to thechamber heater for at least a portion of the predetermined time, andiii) after the predetermined time, switch off the gases supplyarrangement, and e) wherein the controller includes stored instructionsto determine the conclusion of treatment of the patient when asubstantial increase of flow of gases is detected exiting the gas supplyarrangement for a second predetermined period of time.
 2. A breathingassistance apparatus according to claim 1, wherein the flow of gases isvaried during the predetermined time to create a varied gases flow suchthat the varied gases flow evaporates condensate from the transportationpathway.
 3. A breathing assistance apparatus according to claim 2,wherein the varied flow of gases is increased from a first gases flow toa second gases flow within a portion of the predetermined time to createan increasing gases flow such that the increasing gases flow evaporatescondensate from the transportation pathway.
 4. A breathing assistanceapparatus according to claim 3, wherein the first gases flow is lessthan the second gases flow.
 5. A breathing assistance apparatusaccording to claim 2, wherein the varied flow of gases comprises pulsesof gases flow within at least a portion of the predetermined time tocreate a pulsing gas flow such that the pulsing gas flow evaporatescondensate from the transportation pathway.
 6. A breathing assistanceapparatus according to claim 5, wherein the controller has storedinstructions to alternatively pulse gas flow and pulse the powersupplied to the pathway heater such that, when the gas flow is beingpulsed, no power is supplied to the pathway heater and, when the pathwayheater power is being pulsed, the gas flow is off.
 7. A breathingassistance apparatus according to claim 1, wherein the flow of gases isdelivered at a fixed speed through the transportation pathway to createa fixed flow such that the fixed flow evaporates condensation from thetransportation pathway.
 8. A breathing assistance apparatus according toclaim 1, wherein the controller includes stored instructions todetermine the conclusion of treatment of the patient when the patientactivates an off button connected to the controller.
 9. A breathingassistance apparatus according to claim 1 further comprising: a) anoutlet temperature sensor measuring a temperature of the flow of gasesat the outlet to the chamber, b) a distal temperature sensor measuring atemperature of the flow of gases at the distal end of the transportationpathway, c) an ambient temperature sensor measuring ambient airtemperature and wherein the controller includes stored instructions to:i) control the pathway heater over the predetermined time such that thetemperature of the flow of gases at the distal end of the transportationpathway, as sensed by the distal temperature sensor, does not exceed asafe temperature level, and ii) monitor the outlet gases temperaturesensor and ambient air temperature sensor, compare the temperature ofthe flow of gases at the outlet and the temperature of the ambient airand, when these are substantially equal, end the predetermined time andswitch off the gases supply arrangement and the pathway heater.
 10. Abreathing assistance apparatus according to claim 9, wherein the outlettemperature sensor is positioned at the outlet to the chamber.
 11. Abreathing assistance apparatus according to claim 1, wherein thecontroller has stored instructions to complete the following stepsfollowing the conclusion of the treatment of the patient: a) pulse gasflow between a first gas flow and a second gas flow during thepredetermined time; and b) pulse the power supplied to the pathwayheater during the predetermined time.
 12. A breathing assistanceapparatus according to claim 1, wherein the apparatus further comprises:a) a distal temperature sensor configured to measure a temperature ofthe flow of gases at the distal end of the transportation pathway, b) anambient temperature sensor configured to measure ambient airtemperature, and c) a chamber heater temperature sensor configured tomeasure the chamber heater temperature, and the controller includesstored instructions to: i) control the pathway heater over thepredetermined time such that a temperature of the gases at the distalend of the transportation pathway, as sensed by the distal temperaturesensor, does not exceed a safe temperature level, and ii) monitor thechamber heater temperature sensor and ambient air temperature sensor,compare the chamber heater temperature and the ambient air temperatureand, when these are substantially equal, end the predetermined time andswitch off the gases supply arrangement and pathway heater.
 13. Abreathing assistance apparatus according to claim 1, wherein thecontroller has stored instructions to pulse power provided to thepathway heater during the predetermined time such that heat delivered bythe pathway heater is pulsed during the predetermined time.